Provider Demographics
NPI:1770923203
Name:MCCANN, KELLY FINCH (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:FINCH
Last Name:MCCANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LEE
Other - Last Name:FINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4114
Mailing Address - Country:US
Mailing Address - Phone:843-449-6414
Mailing Address - Fax:843-497-0357
Practice Address - Street 1:216 MALL BLVD, SUITE 100
Practice Address - Street 2:LASIKPLUS
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:610-265-5228
Practice Address - Fax:610-265-1560
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2139152W00000X
PAOEG002877152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist